An international outbreak of Vero cytotoxin-producing Escherichia coli O157 infection amongst tourists; a challenge for the European infectious disease surveillance network

In March 1997, an outbreak of Vero cytotoxin-producing Escherichi coli O157 (VTEC) infection occurred amongst holidaymakers returning from Fuerteventu ra, Canary Islands. For the investigation, a confirmed case was an individu al staying in Fuerteventura during March 1997, with either E. coli O157 VTE C isolated in stool, HUS or serological evidence of recent infection; a pro bable case was an individual with bloody diarrhoea without laboratory confi rmation. Local and Europe-wide active case finding was undertaken through n ational centres, Salm-Net and the European Programme of Intervention Epidem iology, followed by a case-control study. Fourteen confirmed and one probable case were identified from England (7), Finland (5), Wales (1), Sweden (1) and Denmark (1) staying in four hotels. Three of the four hotels were supplied with water from a private well which appeared to be the probable vehicle of transmission. The case-control stud y showed illness was associated with consumption of raw vegetables (OR 8.4, 95% CI 1.5-48.2) which may have been washed in well water. This investigation shows the importance of international collaboration in t he detection and investigation of clusters of enteric infection.